DAYTON, Ohio (AP) – A girl in southwest Ohio was diagnosed this month with diphtheria, an illness that has been extremely rare in the U.S. since children started being vaccinated against it in the 1920s, health officials said.

She was diagnosed after being hospitalized with symptoms similar to strep throat, according to the Dayton Daily News. The girl, who was released from the Dayton hospital earlier this month, may have contracted the illness despite being fully vaccinated.

“Anyone getting diphtheria in the United States is rare,” said Dr. Thomas Herchline, medical director for the health department serving Dayton and Montgomery County. “The bottom line is that we know the vaccine is highly effective. The possibility is there that this was a vaccine failure.”

The illness, once a major cause of death among children, is rare in modern times. According to the Centers for Disease Control and Prevention, fewer than five cases were reported in the United States in the past 10 years.

The Ohio Department of Health said diphtheria is spread through close contact with discharges from an infected person’s nose, throat, eyes or skin lesions. Symptoms, which usually appear two to five days after infection, include fever, sore throat and fatigue. An infection in the skin could cause a scaling rash.

Death occurs in about 5 to 10 percent of all cases, according to the state health department. However, serious complications such as paralysis, heart failure and blood disorders may follow if the disease goes untreated.

As a precaution, family members and others within close proximity to the girl were treated for diphtheria. No other cases have been reported, and officials don’t expect others.

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